Research Article
BibTex RIS Cite

Reliability and Validity of Analiz Sistem in Plantar Pressure Assessment for Unilateral Chronic Ankle Instability

Year 2025, Issue: 26, 464 - 476, 31.08.2025
https://doi.org/10.38079/igusabder.1612607

Abstract

Aim: Pedobarography is a valuable tool for understanding lower limb biomechanics and identifying deviations in plantar pressure distribution, particularly in individuals with chronic ankle instability (CAI). Accurate assessment is essential for tailoring effective rehabilitation programs. This study aims to evaluate the concurrent validity and test-retest reliability of Analiz Sistem and Sensor Medica pedobarographic devices in assessing plantar pressure distribution under static postural conditions in individuals with CAI.
Method: A total of 64 participants with unilateral CAI were included, with diagnoses confirmed via a Cumberland Ankle Instability Tool (CAIT) score of ≤24. Static postural assessments focused on surface area and impulse parameters for rearfoot, midfoot, and forefoot regions. Measurements from both systems were analyzed for agreement using Intraclass Correlation Coefficient (ICC), standard error of measurement (SEM), paired t-tests, and Bland-Altman plots.
Results: ICC values ranged from 0.80 to 0.99, demonstrating good to excellent reliability. Rearfoot metrics showed the highest reliability, with ICC values exceeding 0.94. SEM values were consistently low (<1.5 for most metrics), indicating high measurement precision. Paired t-tests revealed no significant differences between the two systems (p>0.05). Bland-Altman plots confirmed narrow limits of agreement and minimal mean bias across all metrics.
Conclusion: Analiz Sistem and Sensor Medica offer accurate and reliable measurements of plantar pressure distribution under static conditions. Their portability and cost-effectiveness make them suitable for clinical and field-based environments. Future research should focus on integrating advanced technologies like artificial intelligence to enhance their utility further.

References

  • 1. Saito M, Nakajima K, Takano C, et al. An in-shoe device to measure plantar pressure during daily human activity. Med Eng Phys. 2011;33(5):638-645. doi: 10.1016/j.medengphy.2011.01.001.
  • 2. McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part I: Can deficits be detected with instrumented testing. J Athl Train. 2008;43(3):293-304. doi: 10.4085/1062-6050-43.3.293.
  • 3. Herb CC, Hertel J. Current concepts on the pathophysiology and management of recurrent ankle sprains and chronic ankle instability. Current Physical Medicine and Rehabilitation Reports. 2014;2:25-34.
  • 4. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: A systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123-140.
  • 5. Gribble PA, Delahunt E, Bleakley CM, et al. Selection criteria for patients with chronic ankle instability in controlled research: A position statement of the International Ankle Consortium. J Athl Train. 2014;49(1):121-127. doi: 10.4085/1062-6050-49.1.14.
  • 6. Morrison KE, Hudson DJ, Davis IS, et al. Plantar pressure during running in subjects with chronic ankle instability. Foot Ankle Int. 2010;31(11):994-1000. doi: 10.3113/FAI.2010.0994.
  • 7. Rosário JL. A review of the utilization of baropodometry in postural assessment. J Bodyw Mov Ther. 2014;18(2):215-219. doi: 10.1016/j.jbmt.2013.05.016.
  • 8. Kernozek TW, LaMott EE. Comparisons of plantar pressures between the elderly and young adults. Gait & Posture 1995;3(3):143-148.
  • 9. Schmidt H, Sauer LD, Lee SY, Saliba S, Hertel J. Increased in-shoe lateral plantar pressures with chronic ankle instability. Foot Ankle Int. 2011;32(11):1075-1080. doi: 10.3113/FAI.2011.1075.
  • 10. Hessert MJ, Vyas M, Leach J, Hu K, Lipsitz LA, Novak V. Foot pressure distribution during walking in young and old adults. BMC Geriatr. 2005;5:8. doi: 10.1186/1471-2318-5-8.
  • 11. Graf PM. The EMED System of foot pressure analysis. Clin Podiatr Med Surg. 1993;10(3):445-454.
  • 12. Jacobs D, Farid L, Ferré S, Herraez K, Gracies JM, Hutin E. Evaluation of the validity and reliability of connected ınsoles to measure gait parameters in healthy adults. Sensors (Basel). 2021;21(19):6543. doi: 10.3390/s21196543.
  • 13. Molinaro L, Russo L, Cubelli F, et al. Reliability analysis of an innovative technology for the assessment of spinal abnormalities. 2022 IEEE International Symposium on Medical Measurements and Applications (MeMeA). IEEE, 2022.
  • 14. Sgrò F, Monteleone G, Pavone M, et al. Validity analysis of Wii Balance Board versus baropodometer platform using an open custom integrated application. AASRI Procedia. 2014;8:22-29.
  • 15. Canavese G, Stassi S, Fallauto C, et al. Real-time pedobarography analysis by piezoresistive wearable insole. Sensor Letters. 2014;12(9):1427-1432.
  • 16. Wright CJ, Arnold BL, Ross SE, Linens SW. Recalibration and validation of the Cumberland Ankle Instability Tool cutoff score for individuals with chronic ankle instability. Arch Phys Med Rehabil. 2014;95(10):1853-1859. doi: 10.1016/j.apmr.2014.04.017.
  • 17. Messina G, Amato A, Rizzo F, et al. The association between masticatory muscles activation and foot pressure distribution in older female adults: A cross-sectional study. Int J Environ Res Public Health. 2023;20(6):5137. doi: 10.3390/ijerph20065137.
  • 18. Koo TK, Li MY. A guideline of selecting and reporting ıntraclass correlation coefficients for reliability research [published correction appears in J Chiropr Med. 2017;16(4):346. doi: 10.1016/j.jcm.2017.10.001]. J Chiropr Med. 2016;15(2):155-163. doi: 10.1016/j.jcm.2016.02.012.
  • 19. Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69-71.
  • 20. Orlin MN, McPoil TG. Plantar pressure assessment. Phys Ther. 2000;80(4):399-409. doi: 10.1093/ptj/80.4.399.
  • 21. Burns J, Crosbie J, Ouvrier R, Hunt A. Effective orthotic therapy for the painful cavus foot: A randomized controlled trial. J Am Podiatr Med Assoc. 2006;96(3):205-211. doi: 10.7547/0960205.
  • 22. Rao S, Riskowski JL, Hannan MT. Musculoskeletal conditions of the foot and ankle: Assessments and treatment options. Best Pract Res Clin Rheumatol. 2012;26(3):345-368. doi: 10.1016/j.berh.2012.05.009.
  • 23. Guiotto A, Sawacha Z, Guarneri G, Cristoferi G, Avogaro A, Cobelli C. The role of foot morphology on foot function in diabetic subjects with or without neuropathy. Gait Posture. 2013;37(4):603-610. doi: 10.1016/j.gaitpost.2012.09.024.
  • 24. Lambrich J, Hagen M, Schwiertz G, Muehlbauer T. Concurrent validity and test-retest reliability of pressure-detecting insoles for static and dynamic movements in healthy young adults. Sensors (Basel). 2023;23(10):4913. doi: 10.3390/s23104913.
  • 25. Burnie L, Chockalingam N, Holder A, Claypole T, Kilduff L, Bezodis N. Testing protocols and measurement techniques when using pressure sensors for sport and health applications: A comparative review. Foot (Edinb). 2024;59:102094. doi: 10.1016/j.foot.2024.102094.
  • 26. Hafer JF, Lenhoff MW, Song J, Jordan JM, Hannan MT, Hillstrom HJ. Reliability of plantar pressure platforms. Gait Posture. 2013;38(3):544-548. doi: 10.1016/j.gaitpost.2013.01.028.
  • 27. Razak AH, Zayegh A, Begg RK, Wahab Y. Foot plantar pressure measurement system: A review. Sensors (Basel). 2012;12(7):9884-9912. doi: 10.3390/s120709884.
  • 28. Nigg BM, Stergiou P, Cole G, Stefanyshyn D, Mündermann A, Humble N. Effect of shoe inserts on kinematics, center of pressure, and leg joint moments during running. Med Sci Sports Exerc. 2003;35(2):314-319. doi: 10.1249/01.MSS.0000048828.02268.79.
  • 29. Willems TM, Witvrouw E, Delbaere K, Mahieu N, De Bourdeaudhuij I, De Clercq D. Intrinsic risk factors for inversion ankle sprains in male subjects: A prospective study. Am J Sports Med. 2005;33(3):415-423. doi: 10.1177/0363546504268137.
  • 30. Molavian R, Fatahi A, Abbasi H, Khezri D. Artificial ıntelligence approach in biomechanics of gait and sport: A systematic literature review. J Biomed Phys Eng. 2023;13(5):383-402. doi: 10.31661/jbpe.v0i0.2305-1621.

Tek Taraflı Kronik Ayak Bileği İnstabilitesinde Plantar Basınç Değerlendirmesinde Analiz Sistem’in Güvenilirliği ve Geçerliliği

Year 2025, Issue: 26, 464 - 476, 31.08.2025
https://doi.org/10.38079/igusabder.1612607

Abstract

Amaç: Pedobarografi, alt ekstremite biyomekaniğini anlamak ve plantar basınç dağılımındaki sapmaları tespit etmek için değerli bir araçtır, özellikle kronik ayak bileği instabilitesi (CAI) olan bireylerde. Doğru değerlendirme, etkili rehabilitasyon programlarının oluşturulmasında kritik bir öneme sahiptir. Bu çalışma, Analiz Sistem ve Sensor Medica pedobarografi cihazlarının statik postüral koşullarda plantar basınç dağılımını değerlendirmedeki eşzamanlı geçerliliğini ve test-tekrar test güvenilirliğini incelemeyi amaçlamaktadır.
Yöntem: Tek taraflı CAI tanısı almış 64 katılımcı çalışmaya dahil edilmiştir ve tanılar Cumberland Ayak Bileği İnstabilite Aracı (CAIT) skorunun ≤24 olmasıyla doğrulanmıştır. Statik postüral değerlendirmeler, arka ayak, orta ayak ve ön ayak bölgeleri için yüzey alanı ve impuls parametrelerine odaklanmıştır. Her iki sistemden elde edilen ölçümler, Intraclass Correlation Coefficient (ICC), ölçüm hatası standart sapması (SEM), eşleştirilmiş t-testi ve Bland-Altman grafikleri kullanılarak analiz edilmiştir.
Bulgular: ICC değerleri 0,80 ile 0,99 arasında değişmiş ve iyi ile mükemmel güvenilirlik sağlamıştır. Arka ayak metrikleri, 0.94’ün üzerinde ICC değerleri ile en yüksek güvenilirliği göstermiştir. SEM değerleri sürekli olarak düşük bulunmuş (<1,5), bu da ölçümlerin yüksek doğruluğunu göstermiştir. Eşleştirilmiş t-testleri, iki sistem arasında anlamlı bir fark olmadığını göstermiştir (p> 0,05). Bland-Altman grafikleri, tüm metriklerde dar uyum sınırları ve minimal ortalama yanlılık doğrulamıştır.
Sonuç: Analiz Sistem ve Sensor Medica, statik koşullarda plantar basınç dağılımını değerlendirmede doğru ve güvenilir ölçümler sunmaktadır. Taşınabilirlikleri ve maliyet etkinlikleri, bu cihazları klinik ve saha ortamları için uygun hale getirmektedir. Gelecekteki araştırmalar, yapay zeka gibi ileri teknolojilerin entegrasyonuna odaklanarak bu cihazların işlevselliğini daha da artırmalıdır.

References

  • 1. Saito M, Nakajima K, Takano C, et al. An in-shoe device to measure plantar pressure during daily human activity. Med Eng Phys. 2011;33(5):638-645. doi: 10.1016/j.medengphy.2011.01.001.
  • 2. McKeon PO, Hertel J. Systematic review of postural control and lateral ankle instability, part I: Can deficits be detected with instrumented testing. J Athl Train. 2008;43(3):293-304. doi: 10.4085/1062-6050-43.3.293.
  • 3. Herb CC, Hertel J. Current concepts on the pathophysiology and management of recurrent ankle sprains and chronic ankle instability. Current Physical Medicine and Rehabilitation Reports. 2014;2:25-34.
  • 4. Doherty C, Delahunt E, Caulfield B, Hertel J, Ryan J, Bleakley C. The incidence and prevalence of ankle sprain injury: A systematic review and meta-analysis of prospective epidemiological studies. Sports Med. 2014;44(1):123-140.
  • 5. Gribble PA, Delahunt E, Bleakley CM, et al. Selection criteria for patients with chronic ankle instability in controlled research: A position statement of the International Ankle Consortium. J Athl Train. 2014;49(1):121-127. doi: 10.4085/1062-6050-49.1.14.
  • 6. Morrison KE, Hudson DJ, Davis IS, et al. Plantar pressure during running in subjects with chronic ankle instability. Foot Ankle Int. 2010;31(11):994-1000. doi: 10.3113/FAI.2010.0994.
  • 7. Rosário JL. A review of the utilization of baropodometry in postural assessment. J Bodyw Mov Ther. 2014;18(2):215-219. doi: 10.1016/j.jbmt.2013.05.016.
  • 8. Kernozek TW, LaMott EE. Comparisons of plantar pressures between the elderly and young adults. Gait & Posture 1995;3(3):143-148.
  • 9. Schmidt H, Sauer LD, Lee SY, Saliba S, Hertel J. Increased in-shoe lateral plantar pressures with chronic ankle instability. Foot Ankle Int. 2011;32(11):1075-1080. doi: 10.3113/FAI.2011.1075.
  • 10. Hessert MJ, Vyas M, Leach J, Hu K, Lipsitz LA, Novak V. Foot pressure distribution during walking in young and old adults. BMC Geriatr. 2005;5:8. doi: 10.1186/1471-2318-5-8.
  • 11. Graf PM. The EMED System of foot pressure analysis. Clin Podiatr Med Surg. 1993;10(3):445-454.
  • 12. Jacobs D, Farid L, Ferré S, Herraez K, Gracies JM, Hutin E. Evaluation of the validity and reliability of connected ınsoles to measure gait parameters in healthy adults. Sensors (Basel). 2021;21(19):6543. doi: 10.3390/s21196543.
  • 13. Molinaro L, Russo L, Cubelli F, et al. Reliability analysis of an innovative technology for the assessment of spinal abnormalities. 2022 IEEE International Symposium on Medical Measurements and Applications (MeMeA). IEEE, 2022.
  • 14. Sgrò F, Monteleone G, Pavone M, et al. Validity analysis of Wii Balance Board versus baropodometer platform using an open custom integrated application. AASRI Procedia. 2014;8:22-29.
  • 15. Canavese G, Stassi S, Fallauto C, et al. Real-time pedobarography analysis by piezoresistive wearable insole. Sensor Letters. 2014;12(9):1427-1432.
  • 16. Wright CJ, Arnold BL, Ross SE, Linens SW. Recalibration and validation of the Cumberland Ankle Instability Tool cutoff score for individuals with chronic ankle instability. Arch Phys Med Rehabil. 2014;95(10):1853-1859. doi: 10.1016/j.apmr.2014.04.017.
  • 17. Messina G, Amato A, Rizzo F, et al. The association between masticatory muscles activation and foot pressure distribution in older female adults: A cross-sectional study. Int J Environ Res Public Health. 2023;20(6):5137. doi: 10.3390/ijerph20065137.
  • 18. Koo TK, Li MY. A guideline of selecting and reporting ıntraclass correlation coefficients for reliability research [published correction appears in J Chiropr Med. 2017;16(4):346. doi: 10.1016/j.jcm.2017.10.001]. J Chiropr Med. 2016;15(2):155-163. doi: 10.1016/j.jcm.2016.02.012.
  • 19. Mukaka MM. Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Med J. 2012;24(3):69-71.
  • 20. Orlin MN, McPoil TG. Plantar pressure assessment. Phys Ther. 2000;80(4):399-409. doi: 10.1093/ptj/80.4.399.
  • 21. Burns J, Crosbie J, Ouvrier R, Hunt A. Effective orthotic therapy for the painful cavus foot: A randomized controlled trial. J Am Podiatr Med Assoc. 2006;96(3):205-211. doi: 10.7547/0960205.
  • 22. Rao S, Riskowski JL, Hannan MT. Musculoskeletal conditions of the foot and ankle: Assessments and treatment options. Best Pract Res Clin Rheumatol. 2012;26(3):345-368. doi: 10.1016/j.berh.2012.05.009.
  • 23. Guiotto A, Sawacha Z, Guarneri G, Cristoferi G, Avogaro A, Cobelli C. The role of foot morphology on foot function in diabetic subjects with or without neuropathy. Gait Posture. 2013;37(4):603-610. doi: 10.1016/j.gaitpost.2012.09.024.
  • 24. Lambrich J, Hagen M, Schwiertz G, Muehlbauer T. Concurrent validity and test-retest reliability of pressure-detecting insoles for static and dynamic movements in healthy young adults. Sensors (Basel). 2023;23(10):4913. doi: 10.3390/s23104913.
  • 25. Burnie L, Chockalingam N, Holder A, Claypole T, Kilduff L, Bezodis N. Testing protocols and measurement techniques when using pressure sensors for sport and health applications: A comparative review. Foot (Edinb). 2024;59:102094. doi: 10.1016/j.foot.2024.102094.
  • 26. Hafer JF, Lenhoff MW, Song J, Jordan JM, Hannan MT, Hillstrom HJ. Reliability of plantar pressure platforms. Gait Posture. 2013;38(3):544-548. doi: 10.1016/j.gaitpost.2013.01.028.
  • 27. Razak AH, Zayegh A, Begg RK, Wahab Y. Foot plantar pressure measurement system: A review. Sensors (Basel). 2012;12(7):9884-9912. doi: 10.3390/s120709884.
  • 28. Nigg BM, Stergiou P, Cole G, Stefanyshyn D, Mündermann A, Humble N. Effect of shoe inserts on kinematics, center of pressure, and leg joint moments during running. Med Sci Sports Exerc. 2003;35(2):314-319. doi: 10.1249/01.MSS.0000048828.02268.79.
  • 29. Willems TM, Witvrouw E, Delbaere K, Mahieu N, De Bourdeaudhuij I, De Clercq D. Intrinsic risk factors for inversion ankle sprains in male subjects: A prospective study. Am J Sports Med. 2005;33(3):415-423. doi: 10.1177/0363546504268137.
  • 30. Molavian R, Fatahi A, Abbasi H, Khezri D. Artificial ıntelligence approach in biomechanics of gait and sport: A systematic literature review. J Biomed Phys Eng. 2023;13(5):383-402. doi: 10.31661/jbpe.v0i0.2305-1621.
There are 30 citations in total.

Details

Primary Language English
Subjects Physical Activity and Health, Sports Science and Exercise (Other), Physiotherapy
Journal Section Articles
Authors

Çağlar Soylu 0000-0002-1524-6295

Ceren Sevval Karatas 0009-0008-1235-3707

Görkem Açar 0000-0002-0970-8625

Early Pub Date August 30, 2025
Publication Date August 31, 2025
Submission Date January 3, 2025
Acceptance Date May 9, 2025
Published in Issue Year 2025 Issue: 26

Cite

JAMA Soylu Ç, Karatas CS, Açar G. Reliability and Validity of Analiz Sistem in Plantar Pressure Assessment for Unilateral Chronic Ankle Instability. IGUSABDER. 2025;:464–476.

 Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)